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| "Bite-formed" posterior composites | "Bite-formed" posterior composites
(a product specific technique only for Clearfil SE Bond or Prelude SE)
1. Cut conservative prep, using Caries Finder or Caries Detector to guide prep and caries removal. (fig. 1)
2. An optional but desirable step is to use air abrasion to clean and roughen the prep after caries removal. (fig.2)
3. Apply SE Bond “Prime” (or Prelude #1) to dry or damp enamel and dentin for 20 sec (Prelude #1 for 10 sec). These are minimum times, longer is OK, agitation improves it. (fig. 3) Take care to be sure that the occlusal margin remains wet with the liquid primer. |
| |  | 4. Air dry only (no wash). (fig. 4)
5. Apply SE Bond “Bond” or Prelude #2(fig. 5), "wicking" off excess SE Bond with a dry Microbrush to avoid a radiolucent layer. It is best to air thin Prelude #2 but avoid air thinning SE Bond (contrary to the manufacturers directions. |
| |  | 6. Light cure. (fig. 7)
7. Place Danville long or short Contact matrix. Wedge if margin needs to be closed. The Danville “ContactWedge” is nifty when there is a long tooth or a concavity. It usually is best to invert the wood wedges, "apex down". When placed upward, the apex tends to distort the contour of the matrix and might even open the contact. Check for centric occlusion and adjust matrix height if necessary. Add Danville Contact ring. If using a rubber dam, be sure matrix does not extend above marginal ridge to allow for CO closure if you plan bite forming (fig.8)The converging tines of the Danville ring allows placement above the wedge with good retention and matrix adaptation. (fig. 9) |
| |  | 8. Apply a thin coat of light cure flowable composite (Starflow, Accolade, or Tetric Flow recommended) with needle tip to cervical margin only (fig. 10). Light cure (fig. 11). Then add flowable composite to all dentin, and on the matrix up to near the contact. Light cure again. (More than one additional increment if over 2 mm.)
9. Place light cure posterior composite (such as Heliomolar for best wear resistance, AP-X or Herculite for best strength) slightly overfilling, taking care to insure all margins are covered. (fig. 12) (One increment will usually suffice after the cured flowable, except in very large or deep preps. Clearfil Photo Core is a nice intermediate material for big increments.) Do not cure yet. |
| |  | 10. Remove Contact ring (and rubber dam if one is used) but do not remove the matrix.
11. Apply Danville Liquid Lens to the occlusal surface of the composite (an air block and separator). (fig. 13)
12. Have patient bite into CO (fig. 14), open. While in CO, is sometimes possible to trans-enamel cure from the buccal. (fig 15) The bite will establish the occlusion, leaving only flash of composite to remove. |
| |  | 13. Have the patient open and light cure from occlusal. A "soft start" cure (150-200 on meter for at least 10 sec.) decreases stress in the composite.
14. Remove the matrix band. It is often helpful to bend the matrix away from the composite before attempting to remove it. Normally a hemostat will be required to sufficiently grip the matrix but even better is Danville’s MegaGrip forcep. (fig. 16)
15. Remove matrix, finish and polish. For final polish, I use Astropol (Ivoclar/Vivadent) cups and points.
16. Option: Etch occlusal, wash, dry, apply Fortify (Bisco), light cure.
17. The restoration is now complete. (fig 18) |
| |  | Reference:
Bite-formed posterior resin composite restorations, placed with a self-etching primer and a novel matrix, Bertolotti RL and Laamanen H, Quintessence International 1999; 30:419-422. |
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